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    Longitudinal outcomes of gender affirming hormone therapy on gender incongruence and psychosocial wellbeing : a mixed methods study : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Clinical Psychology at Massey University, Wellington, Aotearoa, New Zealand
    (Massey University, 2023) Reynolds, Emma
    Access to Gender Affirming Hormone Therapy (GAHT) has increased internationally and in Aotearoa, New Zealand, in recent years. While majority of research supports the positive impact of GAHT on gender congruence and wellbeing, there is a dearth of longitudinal data specifically within Aotearoa. To address this gap, I conducted a mixed methods study to explore the longitudinal outcomes of GAHT on gender congruence and psychosocial wellbeing. In study one, 35 participants aged between 18 and 59 years (m = 27.5) completed the Patient Health Questionnaire (PHQ-SADS) measuring somatic, depressive, and anxious symptomology, the Personal Wellbeing Index (PWI), the Transgender Congruence Scale (TCS), and a Visual Analogue Scale tracking their personalised goals (GTF). Survey scores were collected at baseline (prior to starting GAHT) and at a six month and 12 month follow up of GAHT commencement. Both binary and non-binary trans identities were included in this study. In total, 22 participants received oestrogen-based gender affirming hormone therapy (E-GAHT) and 13 participants received testosterone-based gender affirming hormone therapy (T-GAHT). Differences between survey responses over time were measured using repeated measures ANOVA. Quantitative findings revealed that scores on the TCS and GTF significantly increased over time, suggesting participants experienced enhanced gender congruence and progress towards their individual GAHT goals after one year of treatment. Responses from the PHQ-SADS did not significantly change over time suggesting that these symptomologies remained stable following GAHT. Similarly, responses from the PWI showed no significant change over time. Of note, participants mean baseline scores on the PHQ-SADS were within the minimal and mild ranges resulting in a floor effect for detecting any reduction in symptomology. Study two comprised of semi structured interviews with 10 participants from study one aged between 21 and 45 years (m=30). Qualitative analysis was performed using Reflexive Thematic Analysis. From this study, five participants were taking T-GAHT and five E-GAHT, six participants identified with a binary trans identity, and four identified with a non-binary or agender trans identity. Qualitative analysis yielded five overarching themes. The first theme highlighted the lengthy and thoughtful decision-making process of participants preceding the initiation of GAHT, reflecting participants' extensive contemplation and understanding of their gender identity and desire to seek GAHT. Themes two, three, and four explored the outcomes of GAHT on the physical body, sense of self, and social interactions. Changes in these three areas were mostly positive and well received, while discussions also acknowledged aspects that GAHT did not affect, such as certain physical changes and certain societal attitudes and reactions towards trans individuals. The fifth theme centred on the importance of support throughout the GAHT journey, encompassing interpersonal relationships, community support, and comprehensive healthcare services. Overall, the research indicated that GAHT did not significantly impact participants' mental health, physical health, or subjective wellbeing after one year. GAHT positively influenced feelings of gender incongruence and the achievement of specific goals. Participants' decisions to pursue GAHT were well considered, and they expressed satisfaction with the outcomes. Additionally, robust social support and access to comprehensive services were deemed essential alongside GAHT. These findings highlight many favourable longitudinal outcomes of GAHT across physical, emotional, and social areas with findings from the qualitative analysis providing further context for the quantitative findings. These findings also underscore the necessity for improved access to GAHT within primary healthcare settings, increased availability of additional gender-affirming services beyond the scope of GAHT, and the need for ongoing advocacy and support for trans people from wider society.
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    Women's decision making process about hormone replacement therapy in the New Zealand context : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2003) Radford, Wendy Lena
    The transitional time of menopause has differential meanings for mid-aged women around the world. The medicalisation of menopause has resulted in the increasing promotion of hormone replacement therapy (HRT) both to alleviate distressing symptoms and prevent future illnesses. It is against a background of constantly changing information that women have to make a complex decision about the benefits and risks of this therapy for short and long term use. The theory of planned behaviour (TPB) (Ajzen, 1985) has been successful in predicting a range of health behaviours but few studies have been conducted to assess its predictive validity on intention to take HRT and to date there has been no assessment of this model in the New Zealand context. The present study was undertaken to discover the factors that influenced decision making about HRT use in New Zealand and to predict women's intention to take it at menopause by applying the TPB. A cross sectional postal survey of 140 mid-aged women randomly selected from the General and Māori electoral rolls measured attitudes, subjective norms and perceived behavioural control as well as moral norms and similar prior behaviour. Results of hierarchical multiple regression analysis supported the utility of the TPB to predict intention to use HRT and also showed that moral norms made a significant independent contribution to the prediction of intention to use HRT. The most important factors that influence New Zealand women's intention to use HRT are both the views of people who are important to them and their own attitudes to this treatment. Having a personal sense of control over following the HRT regime and believing it is right to do so and not a sign of weakness are also important considerations. Taking the contraceptive pill in the past has no influence on the decision making process about future HRT use.
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    New Zealand women's preference for treatment decision-making when considering hormone replacement therapy : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2002) McLellan, Tracey
    The menopause phase has increasingly been defined as a deficiency disease amenable to treatment. The main medical treatment for menopause is Hormone Replacement Therapy (HRT). At present very little is known about how New Zealand women make their decisions regarding HRT. What is known is that the medical information concerning HRT is uncertain and doctors are an important factor in the decision-making process. Recent research has shown that there is much dissatisfaction with the service doctors are providing New Zealand women. Much of this dissatisfaction may result from the mismatch of decision-making styles between doctors and women. Accordingly it was necessary to investigate the style preferences of New Zealand women. The aim of the present study was to test the Charles, Gafni & Whelan (1999) theoretical framework for treatment decision-making on New Zealand women considering HRT. The present study seeks to identify three distinct styles of decision-making preference and investigate whether the style preferences are maintained throughout the entire process. One hundred and forty-eight mid-aged women were surveyed about their decisional style preferences. The measure used was designed specifically for the present study and was unique with regard to incorporating stages within the decision-making process. The Charles et al. (1999) framework was found to be an appropriate model for conceptualising the decision-making context of HRT. Support was also found for the dynamic nature of treatment decision-making proposed by Charles et al. (1999) as the three main styles were also found to be amenable to change. The Charles et al. (1999) framework could be a useful educational and assessment tool for doctors and women. Future research is needed to replicate the results of the present study.
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    Hormone replacement therapy use and everyday memory in mid-aged New Zealand women : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Arts in Psychology at Massey University
    (Massey University, 2000) Hamilton, Yolande M
    There continues to be inconsistent evidence as to the extent that Hormone Replacement Therapy (HRT) may preserve memory performance in menopausal women. The Rivermead Behavioural Memory Test-Extended Version (RBMT-E) is a new measure of everyday memory developed for normal populations. The RBMT-E was used to test the everyday memory in a sample of 104 mid-aged New Zealand women (53 HRT users & 51 non-users). Measures of mood, affect, stress, general health and menopausal symptoms as well as age and education were also taken to control for possible confounds. Results showed significant differences (p< 0.5) between the groups for three sub-tests: 'Story Immediate', 'Story Delayed', and 'Message Delayed'. After calculation of a total profile score and adjustments for age and IQ, HRT users scored more highly than non HRT users on the RBMT-E overall measure of Everyday Memory. Conclusions suggest that HRT use does show a relationship with verbal memory, and that the potentially beneficial effect may assist in the performance of everyday memory tasks.
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    Menopause, mood and memory : the effect of hormone replacement therapy on mood and everyday memory in mid-life women : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University
    (Massey University, 2001) Bristow, Virginia Margaret
    There is considerable neuro-scientific evidence that oestrogen influences memory and enhances mood because of its influence on brain mechanisms. Research on the effect of hormone replacement therapy (HRT) on both mood and memory is equivocal although findings indicate that oestrogen may enhance verbal memory. It has been suggested that this area of research should expand to include ecologically valid measures of everyday memory. This study examined the effect of HRT on mood and everyday memory in two separate samples of mid-life women. A cross-sectional comparison of HRT users and non-users among 124 women aged between 40 and 60 years showed that there were no significant differences in mood between HRT users and non-users. However, HRT users performed significantly better on tests of everyday memory and delayed verbal memory when the effects of age, IQ, and education were controlled for. A within-subjects comparison, using the same measures, with 17 women before, and 3 months after, HRT use, showed that negative mood states were reduced and positive mood states were enhanced by HRT, when change in stressful life events, self-rated health, sleep problems, vasomotor symptoms, and exercise were controlled for. The longitudinal sample also showed that everyday memory, working memory, and delayed verbal memory improved with HRT use. The improvement in memory was not mediated by mood. These results suggest that the effect of HRT on mood may only be short-term but that oestrogen does enhance everyday memory.